Endovascular management options and techniques for ruptured thoracoabdominal aortic aneurysm

Objective Open surgical repair of ruptured thoracoabdominal aortic aneurysm (rTAAA) carries significant risk of mortality and morbidity; in the recent years, endovascular repair has emerged as a suitable alternative. This article aims to review current available technologies, techniques, and outcomes for endovascular repair of rTAAA. Methods A narrative review of current literature was performed. Results Off-the-shelf branched endografts are available and are often the first-line endovascular therapy for type I-III rTAAA or type IV rTAAA with a lumen diameter ≥ 24 mm at the level of the reno-visceral vessels. In patients with unsuitable anatomy for off-the-shelf branch devices, particularly those with ruptured type IV or pararenal TAAA with narrow aortic lumen, endovascular repair with in-situ laser fenestration is a reasonable alternative. Physician-modified devices as well as endovascular repair with parallel stent grafts (chimney, periscope, sandwich, or Octopus) has been described by select centers with satisfactory outcomes. Conclusions Patients with rTAAA and suitable anatomy who are at high- or prohibitive-surgical risk can be managed endovascularly with comparative outcomes. Various techniques are described in the literature, and the choices of technique used should depend on patient anatomy and surgeon expertise.